Utility of routine exercise treadmill testing early after percutaneous coronary intervention
Tóm tắt
There have been few prospective studies examining the utility of routine exercise treadmill testing (ETT) early after percutaneous coronary intervention (PCI). The objective of this study was to examine the impact of a routine ETT strategy early after PCI on follow-up cardiac events and procedures. We examined 136 patients who underwent routine ETT at 6 weeks post-PCI in the ADORE trial. The ETT was classified as positive, indeterminate, or negative. The Duke Treadmill Score (DTS) was calculated for all patients. Follow-up occurred at 9 months. ETT results at 6 weeks were: 32 (23.5%) positive, 24 (17.6%) indeterminate and 80 (58.8%) negative. At 9 months, the composite event rate was 21.9% in those with a positive ETT, 20.8% in those with an indeterminate ETT and 12.5% in those with a negative ETT (p = 0.25 positive vs. negative ETT). The sensitivity of early ETT for predicting clinical events was 41.2%, the specificity was 73.3%, the positive predictive value was 21.9% and the negative predictive value was 87.5%. At 9 months, the cardiac procedure rate was 18.8% in those with a positive test, 13.0% in those with an indeterminate test, and 6.3% in those with a negative test (p = 0.07 positive vs. negative ETT). In a multivariate logistic regression model, coronary stenting during PCI and a ≥ 85% MPHR achieved were found to be inversely associated with clinical events. However, the DTS did not independently predict clinical events. Although the statistical power of the study was limited by the small number of clinical events (particularly MI and death), the results of this study support the ACC/AHA guidelines that exercise treadmill testing should not be used routinely after PCI.
Tài liệu tham khảo
Betriu A, Masotti M, Serra A, Alonso J, Fernandez-Aviles F, Gimeno F, Colman T, Zueco J, Delcan JL, Garcia E, Calabuig J: Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START): a four-year follow-up. J Am Coll Cardiol. 1999, 34: 1498-506. 10.1016/S0735-1097(99)00366-6.
Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J, Sigwart U, Colombo A, Goy JJ, van den Heuvel P, Delcan J, Morel MA, for The Benestent Study Group: A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease: The Benestent study goup. N Engl J Med. 1994, 331: 489-495. 10.1056/NEJM199408253310801.
Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman M, Heuser R, Almond D, Teirstein PS, Fish RD, Colombo A, Brinker J, Moses J, Shaknovich A, Hirshfeld J, Bailey S, Ellis S, Rake R, Goldberg S, for The Stent Restenosis Study Investigators: A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease: Stent Restenosis Study Investigators. N Engl J Med. 1994, 331: 496-501. 10.1056/NEJM199408253310802.
Mercado N, Boersma E, Wijns W, Gersh BJ, Morillo CA, de Valk V, van Es GA, Grobbee DE, Serruys PW: Clinical and quantitative coronary angiographic predictors of coronary restenosis: a comparative analysis from the balloon-to-stent era. J Am Coll Cardiol. 2001, 38: 645-52. 10.1016/S0735-1097(01)01431-0.
Pfisterer M, Rickenbacher P, Kiowski W, Muller-Brand J, Burkart F: Silent ischemia after percutaneous transluminal coronary angioplasty: incidence and prognostic significance. J Am Coll Cardiol. 1993, 22: 1446-54.
Desmet W, De Scheerder I, Piessens J: Limited value of exercise testing in the detection of silent restenosis after successful coronary angioplasty. Am Heart J. 1995, 129: 452-9. 10.1016/0002-8703(95)90267-8.
Ruygrok PN, Webster MWI, de Valk V, van Es GA, Ormiston JA, Morel MM, Serruys PW: Clinical and angiographic factors associated with asymptomatic restenosis after percutaneous coronary intervention. Circulation. 2001, 104: 2289-94.
Eisenberg MJ, Schechter D, Lefkovits J, Goudreau E, Deligonul U, Mak KH, Del Core M, Duerr R, Garzon PM, Huynh T, Smilovitch M, Sedlis S, Brown DL, Brieger D, Pilote L, ROSETTA Investigators: Use of routine functional testing after percutaneous transluminal coronary angioplasty: results from the ROSETTA registry. Am Heart J. 2001, 141: 837-46. 10.1067/mhj.2001.114373.
Gidengil C, Garzon P, Eisenberg MJ: Functional testing after percutaneous transluminal coronary angioplasty in Canada and the United States: a survey of practice patterns. Can J Cardiol. 2000, 16: 739-46.
El-Tamimi H, Davies GJ, Hackett D, Fragasso G, Crea F, Maseri A: Very early prediction of restenosis after successful coronary angioplasty: anatomic and functional assessment. J Am Coll Cardiol. 1990, 15: 259-64.
De la Morena G, Sanchez-Munoz JJ, Lopez Candel J, Pico-Aracil F, Ruiperez JA: Early and late exercise testing. Usefulness after percutaneous transluminal coronary angioplasty. Chest. 1993, 103: 391-5.
Honan MB, Bengtson JR, Pryor DB, Rendall DS, Stack RS, Hinohara T, Skelton TN, Califf RM, Hlatky MA, Mark DB: Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction. Circulation. 1989, 80: 1585-94.
Legrand V, Raskinet B, Laarman G, Danchin N, Morel MA, Serruys PW: Diagnostic value of exercise electrocardiography and angina after coronary artery stenting. Benestent Study Group. Am Heart J. 1997, 133: 240-8. 10.1016/S0002-8703(97)70214-X.
Michaelides AP, Dilaveris PE, Psomadaki ZD, Aggelakas S, Stefanadis C, Cokkinos D, Gialafos J, Toutouzas PK: Reliability of the exercise-induced ST-segment changes to detect restenosis three months after coronary angioplasty: significance of the appearance in other leads. Am Heart J. 1998, 135: 449-56. 10.1016/S0002-8703(98)70321-7.
Sheppard R, Schechter D, Azoulay A, Witt H, Garzon P, Eisenberg MJ: Results of a routine exercise treadmill testing strategy early after percutaneous transluminal coronary angioplasty. Can J Cardiol. 2001, 17: 407-14.
Garzon PP, Eisenberg MJ: Functional testing for the detection of restenosis after percutaneous transluminal coronary angioplasty: a meta-analysis. Can J Cardiol. 2001, 17: 41-8.
Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O'Reilly MG, Winters WL, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the 1997 Exercise Testing Guidelines: ACC/AHA 2002 Guideline Update for Exercise Testing. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 2002, 106: 1883-92. 10.1161/01.CIR.0000034670.06526.15.
Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T: Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001, 104: 1694-740.
Mark DB, Shaw L, Harrell FE, Hlatky MA, Lee KL, Bengtson JR, McCants CB, Califf RM, Pryor DB: Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991, 325: 849-53.
Shaw LJ, Peterson ED, Shaw LK, Kesler KL, DeLong ER, Harrell FE, Muhlbaier LH, Mark DB: Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation. 1998, 98: 1622-30.
Froelicher VF, Myers JN: Exercise and the heart. 2000, Philadelphia: WB Saunders and Co, 4
Krone RJ, Hardison RM, Chaitman BR, Gibbons RJ, Sopko G, Bach R, Detre KM: Risk stratification after successful coronary revascularization: the lack of a role for routine exercise testing. J Am Coll Cardiol. 2001, 38: 136-42. 10.1016/S0735-1097(01)01312-2.
Hamasaki S, Arima S, Tahara M, Kihara K, Shono H, Nakao S, Tanaka H: Increase in the delta ST/delta heart rate (HR) index: a new predictor of restenosis after successful percutaneous transluminal coronary angioplasty. Am J Cardiol. 1996, 78: 990-5. 10.1016/S0002-9149(96)00522-X.
Hamasaki S, Abematsu H, Arima S, Tahara M, Kihara K, Shono H, Nakao S, Tanaka H: A new predictor of restenosis after successful percutaneous transluminal coronary angioplasty in patients with multivessel coronary artery disease. Am J Cardiol. 1997, 80: 411-5. 10.1016/S0002-9149(97)00387-1.
Koide Y, Yotsukura M, Ando H, Yoshino H, Ishikawa K: Accuracy of treadmill exercise electrocardiography in detecting restenosis following single-vessel percutaneous transluminal coronary angioplasty. Am J Cardiol. 1997, 80: 1282-6. 10.1016/S0002-9149(97)00666-8.
El-Tamimi H, Davies GJ, Sritara P, Hackett D, Crea F, Maseri A: Inappropriate constriction of small coronary vessels as a possible cause of a positive exercise test early after successful coronary angioplasty. Circulation. 1991, 84: 2307-12.
Koide Y, Yotsukura M, Tajino K, Yoshino H, Ishikawa K: Use of QT dispersion measured on treadmill exercise electrocardiograms for detecting restenosis after percutaneous transluminal coronary angioplasty. Clin Cardiol. 1999, 22: 639-48.
Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE: Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002, 346: 793-801. 10.1056/NEJMoa011858.
Spin JM, Prakash M, Froelicher VF, Partington S, Marcus R, Do D, Myers J: The prognostic value of exercise testing in elderly men. Am J Med. 2002, 112: 453-9. 10.1016/S0002-9343(02)01065-3.
Vanhees L, Fagard R, Thijs L, Staessen J, Amery A: Prognostic significance of peak exercise capacity in patients with coronary artery disease. J Am Coll Cardiol. 1994, 23: 358-63.
Morrow K, Morris CK, Froelicher VF, Hideg A, Hunter D, Johnson E, Kawaguchi T, Lehmann K, Ribisl PM, Thomas R, Ueshima K, Froelicher E, Wallis J: Prediction of cardiovascular death in men undergoing noninvasive evaluation for coronary artery disease. Ann Intern Med. 1993, 118: 689-95.
Valeur N, Clemmensen P, Saunamaki K, Grande P, DANAMI-2 investigators: The prognostic value of pre-discharge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI-2 sub-study. Eur Heart J. 2005, 26: 119-27. 10.1093/eurheartj/ehi057.
Gulati M, Black HR, Shaw LJ, Arnsdorf MF, Merz CN, Lauer MS, Marwick TH, Pandey DK, Wicklund RH, Thisted RA: The prognostic value of a nomogram for exercise capacity in women. N Engl J Med. 2005, 353: 468-75. 10.1056/NEJMoa044154.
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